Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Aug 6, 2016; 7(3): 463-468
Published online Aug 6, 2016. doi: 10.4292/wjgpt.v7.i3.463
Response of irritable bowel syndrome with constipation patients administered a combined quebracho/conker tree/M. balsamea Willd extract
Kenneth Brown, Brandi Scott-Hoy, Linda W Jennings
Kenneth Brown, Brandi Scott-Hoy, KBS Research LLC, Dallas, TX 75248, United States
Linda W Jennings, Annette C and Harold C Simmons Transplant Institute, Baylor Scott and White Health, Dallas, TX 75246, United States
Author contributions: Brown K and Scott-Hoy B contributed equally to this work; Brown K and Scott-Hoy B substantially contributed to conception, design and interpretation of the case series data, critical revisions of the manuscript, and final approval of the manuscript; Jennings LW contributed substantially to the analysis and interpretation of the case series data, critical revision and important intellectual concepts in the manuscript and final approval of the manuscript.
Institutional review board statement: The study is exempt from IRB review and oversight pursuant to the terms of the United States Department of Health and Human Service’s Policy for Protection of Human Research Subjects at 45 CFR and 46.101(b) since the data already exists in patient medical charts and this data was accumulated retrospectively. There was no experimentation on patients. The botanical extract was recommended to patients who chose to take the formulation.
Informed consent statement: All patients gave their verbal consent for publication of their anonymous medical chart data.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Brandi Scott-Hoy, MD, KBS Research LLC, 15660 N Dallas Parkway, Suite 700, Dallas, TX 75248, United States. brandi@kbsresearch.com
Telephone: +1-214-9843724
Received: February 23, 2016
Peer-review started: February 23, 2016
First decision: March 30, 2016
Revised: May 8, 2016
Accepted: June 14, 2016
Article in press: June 16, 2016
Published online: August 6, 2016
Processing time: 111 Days and 18.6 Hours
Abstract

The aim of this case series was to retrospectively examine the symptom response of irritable bowel syndrome with constipation (IBS-C) patients administered an herbal extract in a real-world setting. Twenty-four IBS-C patients in a community office practice were provided a combination over-the-counter dietary supplement composed of quebracho (150 mg), conker tree (470 mg) and M. balsamea Willd (0.2 mL) extracts (Atrantil™) and chose to take the formulation for a minimum of 2 wk in an attempt to manage their symptoms. Patient responses to the supplement were assessed by visual analogue scale (VAS) for abdominal pain, constipation and bloating at baseline and at 2 wk as part of standard-of-care. Patient scores from VAS assessments recorded in medical chart data were retrospectively compiled and assessed for the effects of the combined extract on symptoms. Sign tests were used to compare changes from baseline to 2 wk of taking the extract. Significance was defined as P < 0.05. Twenty-one of 24 patients (88%) responded to the dietary supplement as measured by individual improvements in VAS scores for abdominal pain, bloating and constipation symptoms comparing scores prior to administration of the extract against those reported after 2 wk. There were also significant improvements in individual as well as mean VAS scores after 2 wk of administration of the combined extract compared to baseline for abdominal pain [8.0 (6.5, 9.0) vs 2.0 (1.0, 3.0), P < 0.001], bloating [8.0 (7.0, 9.0) vs 1.0 (1.0, 2.0), P < 0.001] and constipation [6.0 (3.0, 8.0) vs 2.0 (1.0, 3.0), P < 0.001], respectively. In addition, 21 of 24 patients expressed improved quality of life while taking the formulation. There were no reported side effects to administration of the dietary supplement in this practice population suggesting excellent tolerance of the formulation. This pilot retrospective analysis of symptom scores from patients before and after consuming a quebracho/conker tree/M. balsamea Willd extract may support the formulation’s use in IBS-C.

Keywords: Irritable bowel syndrome; Constipation; Abdominal pain; Bloating; Dietary supplement; Herbal; Botanical; Extract; Peppermint

Core tip: Irritable bowel syndrome with constipation (IBS-C) is a diagnosis by exclusion which is defined by abdominal pain accompanied by reduced stool frequency and painful, hard bowel movements. Gas and bloating may also be present in many patients with this condition suggesting a role in fermentation of food producing gas by bacteria in the gut. Safe tannin byproducts from wineries used in cows to reduce gas that can impair milk and meat production are combined with saponins, shown to be antibacterial and promote intestinal motility, and peppermint oil for abdominal pain in this combination extract (Atrantil™) to manage key IBS-C symptoms.